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  • PART I ADMINISTRATION OF THE GOVERNMENT
  • TITLE XVI PUBLIC HEALTH
  • CHAPTER 111 PUBLIC HEALTH
  • Section 217 Office of patient protection; duties

[ Text of section effective until January 1, 2014. Repealed by 2013, 35, Sec. 7. See 2013, 35, Sec. 104.]

  Section 217. (a) There is hereby established within the department an office of patient protection. The office shall:-

  (1) have the authority to administer and enforce the standards and procedures established by sections 13, 14, 15 and 16 of chapter 176O, and to promulgate regulations therefor. Such regulations shall protect the confidentiality of any information about a carrier or utilization review organization, as defined in said chapter 176O, which, in the opinion of the office, and in consultation with the division of insurance, is proprietary in nature. The regulations authorized by this section shall be consistent with, and not duplicate or overlap with, regulations promulgated by the bureau of managed care established in the division of insurance pursuant to said chapter 176O;

  (2) establish a site on the internet and through other communication media in order to make managed care information collected by the office readily accessible to consumers. Said internet site shall, at a minimum, include: (i) a chart, prepared by the office, comparing the information obtained on premium revenue expended for health care services under clause (3) of subsection (b) of section 7 of chapter 176O, for the most recent year for which information is available; and (ii) data collected under subsection (c).

  (3) assist consumers with questions or concerns relating to managed care, including but not limited to exercising the grievance and appeals rights established by sections 13 and 14, of said chapter 176O;

  (4) monitor quality-related health insurance plan information relating to managed care practices;

  (5) regulate the establishment and functions of review panels established by section 14 of chapter 176O;

  (6) periodically advise the commissioner, the managed care oversight board established by section 16D of chapter 6A, the joint committee on health care and the joint committee on insurance on actions, including legislation, which may improve the quality of managed care health insurance plans; and

  (7) administer and grant enrollment waivers under paragraph (4) of subsection (a) of section 4 of chapter 176J; provided, however, that the office of patient protection may grant a waiver to an eligible individual who certifies, under penalty of perjury, that such individual did not intentionally forego enrollment into coverage for which the individual is eligible and that is at least actuarially equivalent to minimum creditable coverage; provided further, that the office shall establish by regulation standards and procedures for enrollment waivers.

  (b) The commissioner shall establish an external review system for the review of grievances submitted by or on behalf of insureds of carriers pursuant to section 14 of chapter 176O.

  (c) Each entity that compiles the health plan employer data and information set, so-called, for the National Committee on Quality Assurance, or collects other information deemed by the entity as similar or equivalent thereto, shall, upon submitting said data and information set to the the center for health information and analysis, concurrently submit to the office of patient protection a copy thereof excluding, at the entity's option, proprietary financial data.